"Do you know where my husband is? Because
he's a good one and I'd hate to lose him." This
is her third husband, so Holly, my
80-something-year-old patient, has room to judge.
I tell her he's reading his book downstairs and she
says, "He's such a patient husband." She asks
this question every five minutes of her two-hour-long
visit. She doesn't know what city she's in, but
she know she's in love with her husband.

A year and a half ago, I was finishing my post
baccalaureate premedical program at Georgetown. I was twenty-four, taking physics with 19-year-olds,
and trying to find a job for the year I would spend
applying to medical school. In an effort to
convince myself that the work was worth it, I read
Final Exam by Pauline Chen, MD. Dr. Chen says
that good doctors recognize when death is inevitable
and then strive to make the transition to death more
comfortable and peaceful. Believing her, I decided
to spend my year learning how to be with patients
with hard diagnoses. I got a job as a research
coordinator for clinical trials for Alzheimer's
disease, which is how I met Holly.

It struck me that Holly was so in love with her
husband when she had lost touch with every other
part of her life. In marriage vows, you
promise to love each other forever. In over 50
percent of marriages, people are unable to keep this
promise, and that’s both frightening and depressing
to people in their twenties considering
marriage—myself included. And yet, as I watch,
my patients and their spouses face the hardest thing
I can imagine together, in the process, they restore
my faith in marriage as a sacred commitment. To love another in sickness and in health is a
profound promise; and yet, it’s the tip of the
iceberg when Alzheimer’s is involved. On your
wedding day, you didn’t promise not to get mad when
your spouse forgets a dentist appointment, forgets
your wedding anniversary, forgets how to converse,
forgets your name. And if you're the one with
Alzheimer's you didn't promise to never give up and
to do your best to fight the disease you’ll
eventually lose your life to. With a diagnosis
of Alzheimer's, these are the vows some choose to
make, spoken or unspoken. And patients who can
do that save their marriages.

Interspersed throughout the struggle are funny
moments, and the only way to keep your sanity is to
laugh. The patients tend to be disinhibited and,
given that most of them were somewhat proper
80-year-olds, the things they say can be unexpected.
When I asked Mr. O’Farrell, my Irish patient, if he
helps out with chores, he said, "Well, sometimes I'm
an ass." Later in the visit, I asked him to
address an envelope to himself and he wrote, "Mr.
Wonderful.” I made a copy of the envelope and
taped it above my desk to keep me smiling. One
caregiver, who’s usually heartbroken at visits,
laughed while telling me that on Valentine’s Day,
two beautiful bouquets arrived because her husband
accidentally ordered flowers twice.